BROKEN ARM

Broken Arm

The arm is the part of the arm found between the wrist and the elbow. It comprises two bones which are the radius and the ulna. Arm fractures usually occur in childhood. They account for over 40% of all childhood fractures. About 75% of arm fractures in children affect the wrist end of the radius.  It’s important to treat a broken arm as soon as possible to prevent complications.

Types of Arm Fractures

Arm fractures can occur in the following areas:

• Radius bone at the wrist
• Radius and he ulna, and
• Ulna (close to the elbow)

In most cases, fractures of the radius occur together with injuries to the ulna. Since the bones are close together, the other bone is usually affected when one of the bones is injured.

Here are the types of broken arms:

Galeazzi fracture

Galeazzi fracture occurs when the radius alone fractures from the ulna. In this case, the end of the ulna usually dislocates at the wrist.

Plastic deformation

This type of arm fracture affects the radius or ulna. Since a child’s growing bones are more elastic than adults’, they can deform (instead of breaking) when they experience excessive force. The deformity remains even after the force has been removed.

Monteggia fracture

Monteggia fracture affects the ulna and radius. In this type of arm fracture, the ulna breaks while the elbow dislocates at the top of the radius.

Nightstick fracture

Nightstick fracture is a type of arm fracture that occurs when the ulna breaks independently of the radius. Since the ulna can be felt from the tip of the elbow to the wrist, it is vulnerable to be fractured when children fall and land on their elbows.

Causes of Broken Arms

Broken arms are usually found in children who are active. They occur while playing and participating in sports. In most cases, broken arms are a result of impact injuries, such as a child falling directly on the arm, a child falling on an outstretched arm, or a direct blow to the arm of the child.

Signs and Symptoms of A Broken Arm

Some of the symptoms of a broken arm include the following:

• Tenderness and swelling
• Difficulty rotating or turning the arm
• Severe pain
• Numbness in the arm or elbow
• Deformity of the arm, wrist, or elbow.

Also, your child may support the fractured arm with the other hand.

Soft Tissue Injuries That Can Occur In The Arm

Issues with the soft tissues usually affect the tendons in the arm. They are often a result of overusing the wrist or elbow. For instance, ‘tennis elbow’ (also referred to as lateral epicondylitis) is a condition whereby the tendons on the external surface of the elbow are inflamed and sore.

Also, tendons on the inside surface of the elbow can get sore (a condition referred to as ‘golfer’s elbow’ or medial epicondylitis).

The general treatment for tendon problems involves resting the wrist and arm and not giving room for any movement that led to the problem. Wearing elbow or wrist supports and physiotherapy can help in this situation.

Diagnosing A Broken Arm

A broken arm is usually noticed after a child falls on an outstretched hand. The bending and rotational force make the bone break. The arm is usually bent and this makes it easy to diagnose a broken arm.

At Medical City Children’s Orthopedics and Spine Specialists, we diagnose a broken arm through a physical examination of the child’s arm, wrist, and elbow. Our expert will check for any deformity of the arm. We will also check for swelling, tenderness, and difficulty in rotating the affected arm.

In most cases, we may recommend carrying out X-rays of the child’s arm to confirm the result of the diagnosis and determine the severity of the injury. X-rays reveal images of bones and they help doctors to know the type of arm fracture your child has so that the right treatment can be recommended.

Apart from a physical examination and X-rays, a broken arm can also be diagnosed through the following means:

Motion tests

A series of motion tests can be carried out to determine how the injury affects the movement and dexterity of the child.

Nerve assessment tests

These are carried out to know if the injury has caused damage or compression of any nerves in the arm or hand of the child.

The more information the doctor can gather about a child’s condition, the better the child’s unique condition can be treated.

Treatment of A Broken Arm

The type of treatment used for a child’s broken arm will be determined by the specific type of fracture, the age, and the development of the child.

Non-surgical treatment

If the arm fracture sustained by the child is not severe and the bone is correctly positioned, the broken arm will most likely be placed in a cast for the bone to heal.

A condition referred to as a ‘closed reduction’ can be performed with children with a simple, displaced fracture (a condition where the bone does not align properly) to reposition the bone. In this treatment method, the bone will be straightened without opening the skin. Local anesthesia will be administered to make the area numb. The arm fragments will then be gently pushed into alignment.

After completing the procedure, a splint or cast will be used to keep the bone in place while it heals. Depending on the severity of the fracture and the degree of swelling after repositioning the bone, a splint can be used for some days to allow the swelling to reduce before applying a cast.

Surgery

Surgery may be required if:

• The broken arm is severe
• The arm fracture broke the skin
• The fracture affected the growth plate, or
• The fracture cannot be repositioned externally.

In this situation, a pediatric anesthesiologist will give the child anesthesia to prevent them from feeling pain and sensation while the surgery is going on. A surgeon will then make an incision to have access to the bones in the arm. The surgeon will align the bones properly.

The surgeon may recommend using a cast, metal pins, plate, and screws, or an external fixator to keep the fracture stabilized and ensure the bones remain in the correct position while healing. Your child’s doctor will inform you about the most effective way to keep the injured arm immobilized while healing.

Complications of a Broken Arm

The commonest complications of broken arms include the following:

Decrease in motion

The limited motion usually occurs after treating broken arms. The limited motion can occur in the elbow and wrist joints but it is usually observed as a limitation in rotating the arm. In other words, an arm fracture can make it difficult for a child to turn a door handle or open a jar.

Inadequate healing of the fracture

arm fracture complications can make the bones of the arm not heal effectively; thereby causing persistent pain. This is usually the case in broken arms where the bone is lost. In this case, repeat surgery for bone grafting may be the solution.

Infection

Infection can occur after any surgery. When infection occurs after fixing a broken arm, the metal plate and screws may need to be removed so that the infection can be cured.

Painful metal implants

The hardware (i.e. metal implants) used during the surgical procedure can be felt under the skin, and this can be painful. If the hardware causes any discomfort, it can be removed at least a year after the surgery.

Recovery of a Broken Arm

How long a cast will be worn depends on how severe the fracture is. For a stable arm fracture, such as a buckle fracture, the cast can be worn for 3 to 4 weeks. A Monteggia fracture and other severe fractures need to be immobilized for about 6 to 10 weeks.

After removing the cast, the joints in the wrist and elbow may remain stiff for 2 to 3 weeks. The stiffness will wade off on its own, so there’s no need for any physical therapy.

Also, the arm bones may be weak as a result of immobilization in the cast. This will only last for a short period. The child must avoid playing on monkey bars and other playground structures for about 3 to 4 weeks after removing the cast so that the bones in the arm can regain their normal strength.

If the fracture affects the growth plate at the end of the bone, it could impede the development of the bone. As a result, the doctor may recommend scheduling follow-up visits for about one year to ensure normal growth.

Request An Appointment For Your Child’s Broken Arm

Medical City Children’s Orthopedics and Spine Specialists has been providing excellent broken arm fractures for many years. We focus on improving the long-term health of your child’s bones. If your child is in pain as a result of a broken arm, call one of our compassionate experts at 214-556-0590 to schedule a free appointment with us.